Individual Worker-Level Attitudes Toward Empirically Supported Treatments.

OBJECTIVES: There is a growing literature indicating that organizational and individual worker-level factors affect decisions about whether or not empirically supported treatments (ESTs) are adopted within health care agencies. The purpose of this pilot study is to further investigate and measure worker's attitudes within a community organization. METHOD: A small organization participated in the study due to their diversity in services offered. Of the 92 workers eligible for participation in the study, 66 (72%) completed the Evidence-Based Practice Attitude scale survey. RESULTS: Multivariate analyses revealed that female workers scored higher on both Openness and total score; workers with nursing, education, or psychology majors scored lower than workers with other (excluding social work) majors on both Divergence and total score; and that older workers scored higher on Divergence. CONCLUSION: Although small, this study identifies individual characteristics that are most likely to fit the profile of an EST adopter.

Repeat Wellens' syndrome: case report of critical proximal left anterior descending artery restenosis.

We describe the case of a 40-year-old woman who presented to the Emergency Department with resolving chest pain. The initial electrocardiogram (ECG) showed biphasic T-waves in V2-V4, which was recognized as Wellens' syndrome, or acute coronary T-wave syndrome. Emergent cardiac catheterization revealed 95% stenosis of the previously placed stent in the proximal left anterior descending artery (LAD). Review of her records from 3 years prior revealed similar ECG findings consistent with Wellens' syndrome, at which time a stent was placed for critical proximal LAD stenosis. We report this case to increase awareness of the T-wave abnormalities associated with Wellens' syndrome. There is significant morbidity and mortality that can occur in the absence of emergent coronary revascularization. This report of repeated Wellens' syndrome in the same patient demonstrates both types of precordial T-wave abnormalities that characterize Wellens' syndrome.

Acute myopericarditis with focal ECG findings mimicking acute myocardial infarction.

BACKGROUND: Although history, physical examination, laboratory data points, and electrocardiogram (ECG) are helpful, distinguishing among pericarditis, myopericarditis, and myocardial infarction can be difficult. OBJECTIVES: This case, which presents as pericarditis with concomitant myocarditis (myopericarditis), illustrates the four evolving ECG stages of pericarditis and highlights some of the potential difficulties in differentiating between myopericarditis and acute myocardial infarction. CASE REPORT: We present the case of a previously healthy 15-year-old boy who presented to the Emergency Department (ED) from his family physician's office for chest pain and presumed pericarditis. The patient's initial ECG showed infero-lateral ST-segment elevation, and his troponin T was elevated at 1.54 ng/mL (ref. < 0.03). Several hours after presentation to the ED, the patient experienced "10/10" chest pain, and a repeat ECG showed ST elevation increased from the prior ECG. After an emergent echocardiogram revealed no regional wall abnormalities, he was transferred to a pediatric cardiac intensive care unit, where a heart catheterization revealed no coronary irregularities. He was discharged 4 days later with the diagnosis of myopericarditis. CONCLUSION: This case report illustrates some of the difficulties in differentiating among myopericarditis and myocardial infarction in a 15-year-old patient presenting with chest pain.

Conversion disorder mimicking serotonin syndrome in an adolescent taking sertraline.

We present the case of a 15-year-old-boy on sertraline (Zoloft) who presented to the Emergency Department with palpitations, tremor, and weakness after starting erythromycin. Upon admission to the hospital, he developed syncopal-like episodes of unresponsiveness associated with body-wide jerking and stiffening as well as tachycardia and hypertension. He was initially believed to have serotonin syndrome and was transferred to a pediatric Intensive Care Unit where the diagnosis of conversion disorder was made. We discuss the salient features of serotonin syndrome and conversion disorder and emphasize the importance of making either diagnosis.

Black cohosh-induced hepatitis.

Herbal products are widely used by American consumers. Herbal remedies are not regulated by the Food and Drug Administration, but they are not immune from serious medication side-effects. We report the case of a 50-year-old woman who presented with fatigue and right upper quadrant pain. The patient had begun the popular postmenopausal herbal remedy black cohosh two weeks prior to presentation. Laboratory results revealed acute hepatitis. After other causes of liver failure were ruled out, the patient was diagnosed with black cohosh-induced hepatitis. She recovered uneventfully following withdrawal of the herb. There are five prior reports of hepatitis or hepatic failure likely caused by the herbal remedy black cohosh in the English literature. This case illustrates the importance of a broad differential diagnosis for abdominal pain and highlights the importance of a complete medication list, including herbs.

Measuring a Community-Based Mental Health Organization's Culture and Climate Scores Stability.

This project builds on the work of Glisson et al. (2008) and the knowledge learned from community-based mental health organizations' internal structures (e.g., culture and climate), which possibly impede the implantation and adoption of new technologies. The Organizational Social Context (OSC) Model measurement system is guided by a model of social context that composes both organizational and individual level constructs, including individual and shared perceptions that are believed to mediate the impact of the organization on the individual. Although the OSC has been developed and validated over time, the literature does not provide guidance on test-retest reliability of the scale.